CAJ | 학술논문

目的探讨神经根型颈椎病患者异常的桡侧腕屈肌Hoffmann反射(H反射)主要代表C6神经根损伤(C5.6节段压迫)还是C7神经根损伤(C6,7节段压迫).方法 41名健康志愿者,20例单侧单节段C6神经根压迫性损伤(C5,6节段存在压迫)和24例单侧单节段C7神经根压迫性损伤(C6,7节段存在压迫)的神经根型颈椎病患者纳入研究.采用针电极于双侧上肢桡侧腕屈肌记录H反射,采集并对比双侧H反射及M波的潜伏期.采用SPSS 15.0统计软件包对测量数据进行统计分析.结果所有健康志愿者的双侧上肢均可记录到可靠的桡侧腕屈肌H反射.神经根型颈椎病患者中,22例C7神经根受压患者患侧桡侧腕屈肌H反射出现异常(22/24,9例表现为H反射消失,其中2例正常侧H反射同样无法诱发；13例表现为较正常侧出现明显的潜伏期延长)；而仅有2例C6神经根受压患者出现桡侧腕屈肌H反射的异常(2/20,均表现为H反射的潜伏期延长)；42例患者正常侧桡侧腕屈肌H反射表现正常,另2例C7神经根压迫性损伤患者出现H反射消失.故在评估C7神经根损伤(C6.7节段压迫)时桡侧腕屈肌H反射的敏感性为83.4％(20/24)明显高于C6神经根损伤(C5,6节段压迫)时的10.0％(2/20).结论异常的桡侧腕屈肌H反射主要出现于存在C7神经根损伤的神经根型颈椎病患者.当神经根型颈椎病患者出现异常的桡侧腕屈肌H反射则提示最可能影响C7神经根的C6,7节段是导致患者症状和体征的责任节段之一.
목적 탐토신경근형경추병환자이상적뇨측완굴기Hoffmann반사(H반사)주요대표C6신경근손상(C5.6절단압박)환시C7신경근손상(C6,7절단압박).방법 41명건강지원자,20례단측단절단C6신경근압박성손상(C5,6절단존재압박)화24례단측단절단C7신경근압박성손상(C6,7절단존재압박)적신경근형경추병환자납입연구.채용침전겁우쌍측상지뇨측완굴기기록H반사,채집병대비쌍측H반사급M파적잠복기.채용SPSS 15.0통계연건포대측량수거진행통계분석.결과 소유건강지원자적쌍측상지균가기록도가고적뇨측완굴기H반사.신경근형경추병환자중,22례C7신경근수압환자환측뇨측완굴기H반사출현이상(22/24,9례표현위H반사소실,기중2례정상측H반사동양무법유발；13례표현위교정상측출현명현적잠복기연장)；이부유2례C6신경근수압환자출현뇨측완굴기H반사적이상(2/20,균표현위H반사적잠복기연장)；42례환자정상측뇨측완굴기H반사표현정상,령2례C7신경근압박성손상환자출현H반사소실.고재평고C7신경근손상(C6.7절단압박)시뇨측완굴기H반사적민감성위83.4％(20/24)명현고우C6신경근손상(C5,6절단압박)시적10.0％(2/20).결론 이상적뇨측완굴기H반사주요출현우존재C7신경근손상적신경근형경추병환자.당신경근형경추병환자출현이상적뇨측완굴기H반사칙제시최가능영향C7신경근적C6,7절단시도치환자증상화체정적책임절단지일.
Objective To identify abnormal Hoffmann-reflex (H-reflex) of the flexor carpi radialis (FCR) is mainly attributed by C7 or C6 nerve root lesion.Methods This study was performed on 41 normal subjects,20 patients with identified C6 radiculopathy(C5,6 level compression) and 24 patients with identified C7 radiculopathy (C6,7 level compression).The FCR H-reflex was performed in all patients bilaterally,and the concentric needle electrode was used to record the FCR H-reflex.The latencies of M wave and H-reflex were measured and compared bilaterally.All data were analyzed using SPSS version 15.0 (IBM,USA) for Windows.Results FCR H-reflexes were reliably recorded in all control group subjects bilaterally.On the involved side,the FCR H-reflex was abnormal in 22 of 24 patients with C7 radiculopathy (absent H-reflexes were seen in 9 patients,including 2 patients with bilateral absent H-reflexes,and 13 patients with siginificant prolonged H-reflex latencies),along with the abnormal FCR H-reflex in 2 of 20 patients with C6 radiculopathy (prolonged H-reflex latencies were seen in these 2 patients).On the uninvolved side,the FCR H-reflex was normal in 42 of 44 patients,and disappeared H-reflex was seen in 2 cases with C7 radiculopathy.The sensitivity of FCR H-reflex in assessing C7 nerve root lesions (C6,7 level compression) (83.4％; 20 of 24) was significantly higher than that in evaluating C6 nerve root lesions (C5.6 level compression) (10.0％; 2 of 20) Conclusion Abnormal FCR Hreflex may mainly suggest C7 nerve root lesion in the present study.The abnormal FCR H-reflex in the patients with cervical radiculopathy always suggests the responsible level is C6,7,which most often affect the C7 nerve root.